الفهرس 
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Abstract
Summary
Abdominal and thoracic surgery is associated with a high incidence of post-operative pulmonary complications leading to longer hospital stays, increased morbidity and mortality, Impairment of pulmonary function, and postoperative atelectasis are common in patients with cardiac surgery .Several interventions and strategies are used to diminish these problems .Chest physiotherapy and deep breathing exercise with positive expiratory(PEP) pressure has long been standard component of post-operative care, with the aim of preventing or reducing pulmonary complications such as impaired pulmonary function, atelectasis, pneumonia, and sputum retention.
The aim this study is to:-
- Evaluate the efficacy of incentive spirometer, conservative therapy, and blow bottle among open heart surgery patients for the prevention of postoperative pulmonary complications.
- Investigate the immediate effect of deep breathing exercises on gas exchange and prevention of pulmonary complications.
Design:-
A quasi –experimental research design was adopted to meet the aim of this study.
Tools of the study
Two tools designed and used by the researcher in this study after reviewing the related literatures.
Tool one: An assessment sheet ”Patient’s socio demographic characteristics and health status tool among cardiothoracic patient, this tool was includes three parts, 1st part, assessment of the patient personal data as( patient name, age, sex, marital status, …….).2nd part Post-operative cardiothoracic patient assessment before and after extubation, consist of (assessment of Respiratory system before extubation includes ,assessment of the initial ventilator parameter at the time of study , assessment of Respiratory system after extubation , Postoperative sternotomy incision pain and laboratory investigations).3rd part ,This part covers evaluation of respiratory system by using: ABG (arterial blood gas) , Pulmonary function test and Chest X-ray was done preoperative and in fourth day postoperative open heart surgery.
Tool two: - Observation checklist for post-operative pulmonary complications among open heart surgery patients: covers comparison between the effect of 3 deep breathing maneuvers (conservative therapy, incentive spirometer, blow bottle) on postoperative pulmonary complications.
Effect of this study showed that:
As regard sciodemograghic date it was found that 56%and 52% of group 1&3 were in age group 30-39 years old respectively, and 48% of group 2 was in age group 18 -29 years old with statistical significant difference between the three groups as regard age .in relation to pulmonary complications it was found complications occur in age >50 years. Regarding to types of operation 40% of patients in group 2&3 having MVR and 72%in group1 having MVR&TVR with statistical significant difference between the three groups.as regard ICU stay this result revealed that the mean value of time in ICU stay were (3.96 ± 0.61& 4.36 ± 1.22) days with no significance difference between three groups p (0.261).regarding to ABG
Concerning the paco2 it was found statistical significant differences were found between the three groups during the first assessments with p-value (0.001). In relation to sao2 it was found that statistical significant difference between the three groups during the first and third assessment (p= 0.033&0.003) respectively, as regards pao2 a statistical significant difference between the three groups during the fourth assessment (p= 0.001). Concerning the WBCs statistical significant differences were found between the three groups during the second assessments and third assessment with p-value (0.001&0.001) respectively .Regarding pulmonary function test it was noticed that decreased FEV1&VC in fourth day postoperatively than preoperative phase with a statistical significant difference was found between the three groups during the first assessment in preoperative phase and second assessment postoperatively in fourth day related to FEV1&VC (p= 0.007&0.009) &(p= 0.0001&0.002) respectively .Concerning to postoperative pulmonary complications a statistical significant difference was found between the three groups regarding to atalectasis p (0.044). As regard pulmonary secretion it was noticed that a highly percent 80%&72% of patients in group 2&1 respectively, while 60% of patients having pulmonary secretion.
Based on finding of this study, it can be concluded that: Major differences were found between patients performing deep breathing exercise alone and deep breathing with a blow bottle or incentive spirometer during the first four postoperative days. Patients who performed deep breathing exercises with a blow bottle device postoperatively showed a significantly smaller amount of atelectasis, improved oxygenation and had less reduction in FVC and FEV1 on the fourth postoperative day compared to conservative therapy. Regarding to secretions the study revealed that patients who performed deep breathing exercises with a blow bottle device and incentive spirometer postoperatively having small amount of secretions with statistical significant difference between the three groups.
Based on the current study finding, it was recommended that:
• Provide training program to update critical care nurses knowledge and skill about new maneuvers of deep breathing.
• Available critical care nurse especial for chest physiotherapy (physiotherapist) must be present in ICU.
• Emphasize the importance of nurse’s skills for prevention of respiratory complications after open heart surgery.
• Explain to the nurse the deference between deep breathing exercise alone and deep breathing exercise with anther maneuver such as incentive spirometer or blow bottle device, and the effectiveness on respiratory system for preventing respiratory complications.
Summary
Abdominal and thoracic surgery is associated with a high incidence of post-operative pulmonary complications leading to longer hospital stays, increased morbidity and mortality, Impairment of pulmonary function, and postoperative atelectasis are common in patients with cardiac surgery .Several interventions and strategies are used to diminish these problems .Chest physiotherapy and deep breathing exercise with positive expiratory(PEP) pressure has long been standard component of post-operative care, with the aim of preventing or reducing pulmonary complications such as impaired pulmonary function, atelectasis, pneumonia, and sputum retention.
The aim this study is to:-
- Evaluate the efficacy of incentive spirometer, conservative therapy, and blow bottle among open heart surgery patients for the prevention of postoperative pulmonary complications.
- Investigate the immediate effect of deep breathing exercises on gas exchange and prevention of pulmonary complications.
Design:-
A quasi –experimental research design was adopted to meet the aim of this study.
Tools of the study
Two tools designed and used by the researcher in this study after reviewing the related literatures.
Tool one: An assessment sheet ”Patient’s socio demographic characteristics and health status tool among cardiothoracic patient, this tool was includes three parts, 1st part, assessment of the patient personal data as( patient name, age, sex, marital status, …….).2nd part Post-operative cardiothoracic patient assessment before and after extubation, consist of (assessment of Respiratory system before extubation includes ,assessment of the initial ventilator parameter at the time of study , assessment of Respiratory system after extubation , Postoperative sternotomy incision pain and laboratory investigations).3rd part ,This part covers evaluation of respiratory system by using: ABG (arterial blood gas) , Pulmonary function test and Chest X-ray was done preoperative and in fourth day postoperative open heart surgery.
Tool two: - Observation checklist for post-operative pulmonary complications among open heart surgery patients: covers comparison between the effect of 3 deep breathing maneuvers (conservative therapy, incentive spirometer, blow bottle) on postoperative pulmonary complications.
Effect of this study showed that:
As regard sciodemograghic date it was found that 56%and 52% of group 1&3 were in age group 30-39 years old respectively, and 48% of group 2 was in age group 18 -29 years old with statistical significant difference between the three groups as regard age .in relation to pulmonary complications it was found complications occur in age >50 years. Regarding to types of operation 40% of patients in group 2&3 having MVR and 72%in group1 having MVR&TVR with statistical significant difference between the three groups.as regard ICU stay this result revealed that the mean value of time in ICU stay were (3.96 ± 0.61& 4.36 ± 1.22) days with no significance difference between three groups p (0.261).regarding to ABG
Concerning the paco2 it was found statistical significant differences were found between the three groups during the first assessments with p-value (0.001). In relation to sao2 it was found that statistical significant difference between the three groups during the first and third assessment (p= 0.033&0.003) respectively, as regards pao2 a statistical significant difference between the three groups during the fourth assessment (p= 0.001). Concerning the WBCs statistical significant differences were found between the three groups during the second assessments and third assessment with p-value (0.001&0.001) respectively .Regarding pulmonary function test it was noticed that decreased FEV1&VC in fourth day postoperatively than preoperative phase with a statistical significant difference was found between the three groups during the first assessment in preoperative phase and second assessment postoperatively in fourth day related to FEV1&VC (p= 0.007&0.009) &(p= 0.0001&0.002) respectively .Concerning to postoperative pulmonary complications a statistical significant difference was found between the three groups regarding to atalectasis p (0.044). As regard pulmonary secretion it was noticed that a highly percent 80%&72% of patients in group 2&1 respectively, while 60% of patients having pulmonary secretion.
Based on finding of this study, it can be concluded that: Major differences were found between patients performing deep breathing exercise alone and deep breathing with a blow bottle or incentive spirometer during the first four postoperative days. Patients who performed deep breathing exercises with a blow bottle device postoperatively showed a significantly smaller amount of atelectasis, improved oxygenation and had less reduction in FVC and FEV1 on the fourth postoperative day compared to conservative therapy. Regarding to secretions the study revealed that patients who performed deep breathing exercises with a blow bottle device and incentive spirometer postoperatively having small amount of secretions with statistical significant difference between the three groups.
Based on the current study finding, it was recommended that:
• Provide training program to update critical care nurses knowledge and skill about new maneuvers of deep breathing.
• Available critical care nurse especial for chest physiotherapy (physiotherapist) must be present in ICU.
• Emphasize the importance of nurse’s skills for prevention of respiratory complications after open heart surgery.
• Explain to the nurse the deference between deep breathing exercise alone and deep breathing exercise with anther maneuver such as incentive spirometer or blow bottle device, and the effectiveness on respiratory system for preventing respiratory complications.
Summary
Abdominal and thoracic surgery is associated with a high incidence of post-operative pulmonary complications leading to longer hospital stays, increased morbidity and mortality, Impairment of pulmonary function, and postoperative atelectasis are common in patients with cardiac surgery .Several interventions and strategies are used to diminish these problems .Chest physiotherapy and deep breathing exercise with positive expiratory(PEP) pressure has long been standard component of post-operative care, with the aim of preventing or reducing pulmonary complications such as impaired pulmonary function, atelectasis, pneumonia, and sputum retention.
The aim this study is to:-
- Evaluate the efficacy of incentive spirometer, conservative therapy, and blow bottle among open heart surgery patients for the prevention of postoperative pulmonary complications.
- Investigate the immediate effect of deep breathing exercises on gas exchange and prevention of pulmonary complications.
Design:-
A quasi –experimental research design was adopted to meet the aim of this study.
Tools of the study
Two tools designed and used by the researcher in this study after reviewing the related literatures.
Tool one: An assessment sheet ”Patient’s socio demographic characteristics and health status tool among cardiothoracic patient, this tool was includes three parts, 1st part, assessment of the patient personal data as( patient name, age, sex, marital status, …….).2nd part Post-operative cardiothoracic patient assessment before and after extubation, consist of (assessment of Respiratory system before extubation includes ,assessment of the initial ventilator parameter at the time of study , assessment of Respiratory system after extubation , Postoperative sternotomy incision pain and laboratory investigations).3rd part ,This part covers evaluation of respiratory system by using: ABG (arterial blood gas) , Pulmonary function test and Chest X-ray was done preoperative and in fourth day postoperative open heart surgery.
Tool two: - Observation checklist for post-operative pulmonary complications among open heart surgery patients: covers comparison between the effect of 3 deep breathing maneuvers (conservative therapy, incentive spirometer, blow bottle) on postoperative pulmonary complications.
Effect of this study showed that:
As regard sciodemograghic date it was found that 56%and 52% of group 1&3 were in age group 30-39 years old respectively, and 48% of group 2 was in age group 18 -29 years old with statistical significant difference between the three groups as regard age .in relation to pulmonary complications it was found complications occur in age >50 years. Regarding to types of operation 40% of patients in group 2&3 having MVR and 72%in group1 having MVR&TVR with statistical significant difference between the three groups.as regard ICU stay this result revealed that the mean value of time in ICU stay were (3.96 ± 0.61& 4.36 ± 1.22) days with no significance difference between three groups p (0.261).regarding to ABG
Concerning the paco2 it was found statistical significant differences were found between the three groups during the first assessments with p-value (0.001). In relation to sao2 it was found that statistical significant difference between the three groups during the first and third assessment (p= 0.033&0.003) respectively, as regards pao2 a statistical significant difference between the three groups during the fourth assessment (p= 0.001). Concerning the WBCs statistical significant differences were found between the three groups during the second assessments and third assessment with p-value (0.001&0.001) respectively .Regarding pulmonary function test it was noticed that decreased FEV1&VC in fourth day postoperatively than preoperative phase with a statistical significant difference was found between the three groups during the first assessment in preoperative phase and second assessment postoperatively in fourth day related to FEV1&VC (p= 0.007&0.009) &(p= 0.0001&0.002) respectively .Concerning to postoperative pulmonary complications a statistical significant difference was found between the three groups regarding to atalectasis p (0.044). As regard pulmonary secretion it was noticed that a highly percent 80%&72% of patients in group 2&1 respectively, while 60% of patients having pulmonary secretion.
Based on finding of this study, it can be concluded that: Major differences were found between patients performing deep breathing exercise alone and deep breathing with a blow bottle or incentive spirometer during the first four postoperative days. Patients who performed deep breathing exercises with a blow bottle device postoperatively showed a significantly smaller amount of atelectasis, improved oxygenation and had less reduction in FVC and FEV1 on the fourth postoperative day compared to conservative therapy. Regarding to secretions the study revealed that patients who performed deep breathing exercises with a blow bottle device and incentive spirometer postoperatively having small amount of secretions with statistical significant difference between the three groups.
Based on the current study finding, it was recommended that:
• Provide training program to update critical care nurses knowledge and skill about new maneuvers of deep breathing.
• Available critical care nurse especial for chest physiotherapy (physiotherapist) must be present in ICU.
• Emphasize the importance of nurse’s skills for prevention of respiratory complications after open heart surgery.
• Explain to the nurse the deference between deep breathing exercise alone and deep breathing exercise with anther maneuver such as incentive spirometer or blow bottle device, and the effectiveness on respiratory system for preventing respiratory complications.
Summary
Abdominal and thoracic surgery is associated with a high incidence of post-operative pulmonary complications leading to longer hospital stays, increased morbidity and mortality, Impairment of pulmonary function, and postoperative atelectasis are common in patients with cardiac surgery .Several interventions and strategies are used to diminish these problems .Chest physiotherapy and deep breathing exercise with positive expiratory(PEP) pressure has long been standard component of post-operative care, with the aim of preventing or reducing pulmonary complications such as impaired pulmonary function, atelectasis, pneumonia, and sputum retention.
The aim this study is to:-
- Evaluate the efficacy of incentive spirometer, conservative therapy, and blow bottle among open heart surgery patients for the prevention of postoperative pulmonary complications.
- Investigate the immediate effect of deep breathing exercises on gas exchange and prevention of pulmonary complications.
Design:-
A quasi –experimental research design was adopted to meet the aim of this study.
Tools of the study
Two tools designed and used by the researcher in this study after reviewing the related literatures.
Tool one: An assessment sheet ”Patient’s socio demographic characteristics and health status tool among cardiothoracic patient, this tool was includes three parts, 1st part, assessment of the patient personal data as( patient name, age, sex, marital status, …….).2nd part Post-operative cardiothoracic patient assessment before and after extubation, consist of (assessment of Respiratory system before extubation includes ,assessment of the initial ventilator parameter at the time of study , assessment of Respiratory system after extubation , Postoperative sternotomy incision pain and laboratory investigations).3rd part ,This part covers evaluation of respiratory system by using: ABG (arterial blood gas) , Pulmonary function test and Chest X-ray was done preoperative and in fourth day postoperative open heart surgery.
Tool two: - Observation checklist for post-operative pulmonary complications among open heart surgery patients: covers comparison between the effect of 3 deep breathing maneuvers (conservative therapy, incentive spirometer, blow bottle) on postoperative pulmonary complications.
Effect of this study showed that:
As regard sciodemograghic date it was found that 56%and 52% of group 1&3 were in age group 30-39 years old respectively, and 48% of group 2 was in age group 18 -29 years old with statistical significant difference between the three groups as regard age .in relation to pulmonary complications it was found complications occur in age >50 years. Regarding to types of operation 40% of patients in group 2&3 having MVR and 72%in group1 having MVR&TVR with statistical significant difference between the three groups.as regard ICU stay this result revealed that the mean value of time in ICU stay were (3.96 ± 0.61& 4.36 ± 1.22) days with no significance difference between three groups p (0.261).regarding to ABG
Concerning the paco2 it was found statistical significant differences were found between the three groups during the first assessments with p-value (0.001). In relation to sao2 it was found that statistical significant difference between the three groups during the first and third assessment (p= 0.033&0.003) respectively, as regards pao2 a statistical significant difference between the three groups during the fourth assessment (p= 0.001). Concerning the WBCs statistical significant differences were found between the three groups during the second assessments and third assessment with p-value (0.001&0.001) respectively .Regarding pulmonary function test it was noticed that decreased FEV1&VC in fourth day postoperatively than preoperative phase with a statistical significant difference was found between the three groups during the first assessment in preoperative phase and second assessment postoperatively in fourth day related to FEV1&VC (p= 0.007&0.009) &(p= 0.0001&0.002) respectively .Concerning to postoperative pulmonary complications a statistical significant difference was found between the three groups regarding to atalectasis p (0.044). As regard pulmonary secretion it was noticed that a highly percent 80%&72% of patients in group 2&1 respectively, while 60% of patients having pulmonary secretion.
Based on finding of this study, it can be concluded that: Major differences were found between patients performing deep breathing exercise alone and deep breathing with a blow bottle or incentive spirometer during the first four postoperative days. Patients who performed deep breathing exercises with a blow bottle device postoperatively showed a significantly smaller amount of atelectasis, improved oxygenation and had less reduction in FVC and FEV1 on the fourth postoperative day compared to conservative therapy. Regarding to secretions the study revealed that patients who performed deep breathing exercises with a blow bottle device and incentive spirometer postoperatively having small amount of secretions with statistical significant difference between the three groups.
Based on the current study finding, it was recommended that:
• Provide training program to update critical care nurses knowledge and skill about new maneuvers of deep breathing.
• Available critical care nurse especial for chest physiotherapy (physiotherapist) must be present in ICU.
• Emphasize the importance of nurse’s skills for prevention of respiratory complications after open heart surgery.
• Explain to the nurse the deference between deep breathing exercise alone and deep breathing exercise with anther maneuver such as incentive spirometer or blow bottle device, and the effectiveness on respiratory system for preventing respiratory complications.
الملخص العربي
مقدمة
وترتبط عملية جراحة البطن والصدر بوجود نسبة عالية من المضاعفات الرئوية بعد الجراحة مما يودى إلى البقاء في المستشفى لفترات طويلة، وزيادة معدلات الاعتلال والوفيات، وانخفاض كفاءه وظائف الرئة، وانخماص الرئة بعد العملية الجراحية شائع في المرضى الذين يعانون من جراحة القلب وتستخدم العديد من التدخلات والاستراتيجيات للحد من هذه المشكلات مثل العلاج الطبيعي والتمارين الرياضية للصدر مع التنفس العميق و حافز قياس التنفس وزجاجة ضربة ، و ذلك لمحاولة تعزيز وظيفة الحجاب الحاجز بعد جراحة القلب المفتوح، والزجاجة الضربة هى أسلوب آخر لتحسين الشهيق و الزفير وكذلك توسيع الرئة. عن طريق استخدم زجاجة مع 10 سم من الماء وأنابيب البلاستيك 40 سم (1 قطرها سم).وذلك بهدف منع أو تقليل المضاعفات الرئوية مثل ضعف وظائف الرئة، انخماص الرئة، والالتهاب الرئوي، و الاحتفاظ بالبلغم لدى المرضى بعد العمليات الجراحية.
الهدف من هذه الدراسة :
• تقييم فعالية الحوافز مقياس التنفس، العلاج المحافظ، وزجاجة ضربة بين مرضى جراحة القلب المفتوح للوقاية من مضاعفات الرئوية بعد العملية الجراحية .
• التحقق من تأثير تمارين التنفس العميق الفوري على تبادل الغازات ومنع المضاعفات الرئوي
المادة و طرق البحث
تصميم البحث:- تصميم مقارنة شبه تجريبية لإنجاز البحث.
مكان اجراء البحث:-سيجري هذا البحث بوحدة العناية المركزة بعد عمليات القلب المفتوح بمستشفي أسيوط الجامعي.
عينة البحث:- جميع المرضى المقرر إجراؤهم من الجنسين وعددهم 75 حالة للمرضى بعد عمليات القلب المفتوح و قسمت هذه العينة إلى ثلاث مجموعات (المجموعة الاولى حافز قياس التنفس, المجموعة الثانية العلاج المحافظ , المجموعة الثالثة زجاجة ضربة)
الأدوات:
اداتان سيتم تطويرهم و استخدامهم من قبل الباحث في هذه الدراسة بعد مراجعة المراجع ذات الصلة.
الاداة الاولي :
”الخصائص الاجتماعية والديموغرافية والبيانات لمريض القلب المفتوح، وهذه الأداة يتضمن ستة أجزاء
الجزء الأول :
تقييم البيانات الشخصية للمريض مثل ( اسم المريض والعمر والجنس---------الخ
الجزء الثاني:
الحالة الطبية للمريض و التاريخ الطبي الماضي مثل(زرقة ، والتهابات العقديات ، والحمى الروماتيزمية ، وبعض الأمراض مثل فشل القلب، و الحساسيةو........... ) ، والتشخيص ، وتاريخ الدخول، الطول اوالوزن و...................)
الجزء الثالث : -
• الأدوية قبل الجراحة ( Intropics ، Antihypertension ، مدرات البول، و سكر الدم ، أخرى )
• العادات الصحية (استعمال الشاي و القهوة، و استخدام الكحول، و التدخين ، وممارسة)
• الأمراض الوراثية ( مرض السكري ، وأمراض الكلى ، وأمراض القلب الخلقية و ارتفاع ضغط الدم ) و جراحة القلب السابق.
الجزء الرابع:
العلامات الحيوية مثل معدل ضربات القلب (HR ) ، ضغط الدم الانقباضي (SBP ) ، ضغط الدم الانبساطي ( DBP ) ، و ضغط الدم الشرياني ، درجة الحرارة و معدل التنفس .
الجزء الخامس : -
تقييم المرضى بعد جراحة القلب المفتوح ’ونزع الأنبوبة من حيث
أ- تقييم المريض على جهاز التنفس الصناعي في وقت الدراسة
ب- معدل التنفس والعمق والسعال (جاف أو السعال الإنتاجية) ، ضيق التنفس ، ضيق النفس الاضطجاعي, -
ج- ألم في الصدر بعد العملية الجراحية ويشمل (ألم في الراحة، ألم في حين أخذ نفسا عميقا، والألم أثناء السعال، وألم في اختبار وظيفة الرئة)
د- والتحاليل الطبية مثل صورة الدم قبل العملية وفي اليوم الثالث بعد العملية
الجزء السادس:
يتضمن هذا الجزء تقييم الجهاز التنفسي باستخدام (غازات الدم الشرياني) كل أربع ساعات بعد نزع الأنبوب في اليومين الأولين وكل 8 ساعات في أيام الثالث والرابع بعد العملية ، واختبار وظائف الرئة القيام به (قبل العملية ، وبعد نزع الأنبوبة في اليوم الرابع بعد العملية) ، و بالأشعة السينية على الصدر (قبل العملية وفي اليوم الرابع بعد العملية).
الأداة الثانية :
قائمة مراقبة المضاعفات اللاحقة لجهاز التنفسى بين مريض القلب المفتوح بعد الجراحة :وتشمل مقارنة تأثير ثلاث مناورات للتنفس العميق (قياس التنفس الحوافز ، والعلاج المحافظ ، زجاجة ضربة) على مضاعفات ما بعد الجراحة الرئوية وهى انخماص الصدر (من خلال سماع صوت الصدر و بالأشعة السينية علي الصدر، اختبار وظائف الرئة ، والغاز الدم). الالتهاب الرئوي (من خلال سماع صوت الصدر و بالأشعة السينية علي الصدر ، والدم الغاز). التهاب الشعب الهوائية (من خلال سماع صوت الصدر و بالأشعة السينية علي الصدر، والغاز الدم). الحمى (من خلال درجة الحرارة عن طريق الفم)
مرحلة التطبيق و التقييم:-
المجموعة الاولى: سوف تتلقى الممارسة المعتادة الروتينية للتنفس وهى (العلاج المحافظ).
المجموعةالثانية : سوف تتلقى العلاج الطبيعي الصدر (حسب مقياس التنفس الحافزة) المجموعةالثالثة: سوف تلقي العلاج الطبيعي الصدر (عن طريق زجاجة ضربة)
أما بالنسبة لجميع الفئات : - تقييم حدوث مضاعفات في الجهاز التنفسي عن طريق تبادل الغازات بواسطة الغاز الدم الشرياني كل أربع ساعات بعد نزع الأنبوبة في اليومين الأولين وكل 8 ساعات في أيام الثالث والرابع بعد العملية. ، قياس درجة الحرارة وستكون هناك مقارنة بين المجموعات الثالثة لمضاعفات في الجهاز التنفسي.
النتائج الرئيسية:
أظهرت تأثير هذه الدراسة ما يلي:
فى دراستنا تبين أن 56٪ و 52٪ من مجموعة 1 و 3 على التوالي في الفئة العمرية 30-39 سنة ، وكان 48٪ من الشريحة 2 في الفئة العمرية 18 -29 سنة مع الفرق ذات دلالة إحصائية بين المجموعات الثلاثة. فيما يتعلق بالمضاعفات الرئوية وجد ان تحدث المضاعفات في عمر اكثر من 50 سنوات. فيما يتعلق بأنواع العملية وجد ان 40 ٪ من المرضى في مجموعة 2 و 3 يخضعون لعملية تغير الصمام المترالى و 72٪ في مجموعة1 يخضعون لعملية تغير الصمام المترالى وTVR مع فروقات ذات دلالة إحصائية بين الثلاث مجموعات .وكشفت النتائج ان لا توجد فروق بين الثلاث مجموعات من حيث عدد الايام والبقاء فى العناية المركزة . بشأن غازات الدم من حيث نسبة ثاني اكسيد الكربون وجدت فروق بين المجموعات الثلاث خلال أول تقيم و فيما يتعلق بنسبة تشبع الاكسجين فى الدم وجد فرق بين المجموعات الثلاثة خلال أول و ثالث تقيم على التوالي، و هناك فرق ذات دلالة إحصائية بين المجموعات الثلاثة خلال التقييم الرابع من حيث نسبة الاكسجين فى الدم.
بشأن الكريات البيضاء تم العثور علي فروق ذات دلالة إحصائية بين المجموعات الثلاثة خلال ثاني وثالث تقيم على التوالي. بشأن وظائف الرئة التجريبى لوحظ أن انخفاض FEV1 وVC في اليوم الرابع بعد العملية عن المرحلة قبل الجراحة مع وجد فروق ذات دلالة إحصائية بين الثلاث مجموعات خلال التقييم الأول قبل الجراحة والمرحلة الثانية بعد الجراحة على التوالي. بشأن المضاعفات الرئوية بعد الجراحة وجدت فروق ذات دلالة إحصائية بين المجموعات الثلاث فيما يتعلق انحماص الرئة . لوحظ أن 80٪ و72٪ من المرضى في مجموعة 2 و 1 على التوالي، في حين أن 60٪ من المرضى فى المجموعة 3 يعانون من وجود افرزات بالرئة.
الخلاصة
استنادا على هذه الدراسة، فإنه يمكن استنتاج أن:
تم العثور على اختلافات كبيرة بين المرضى الذين يؤدون ممارسة التنفس العميق وحده، والتنفس العميق مع زجاجة ضربة أو حافز مقياس التنفس خلال الأربعة أيام الأولى ما بعد الجراحة. المرضى الذين أجريت التنفس العميق تمارين مع جهاز زجاجة ضربة بعد العمل الجراحي وأظهرت كمية أصغر بكثير من انخماص الرئة، تحسين الأوكسجين، وكان أقل انخفاض في FVC و FEV1 في اليوم الرابع بعد الجراحة مقارنة بالعلاج المحافظ. وبالنسبة لإفرازات وكشف الدراسة أن المرضى الذين أجريت لهم تمارين التنفس العميق مع جهاز زجاجة ضربة او حافز مقياس التنفس بعد الجراحة وجود كمية صغيرة من افرازات مع الفرق ذات دلالة إحصائية بين المجموعات الثلاث.
التوصيات:
استنادا إلى النتائج الدراسة الحالية ، أوصي بأن :
- توفير برنامج تدريبي لتحديث المعرفة و المهارات حول مناورات جديدة من التنفس العميق. لممرضات الرعاية الحرجة • يجب أن تكون تتوفر ممرضة بالرعاية الحرجة خاصة للعلاج الطبيعي للصدر) في وحدة العناية المركزة .
- التأكيد على أهمية المهارات التنفسية للوقاية من مضاعفات في الجهاز التنفسي بعد جراحة القلب المفتوح .
- يكرر هذا البحث على عينة كبيرة الحجم لتقييم تأثير العلاج الطبيعي الصدر على منع حدوث مضاعفات في الجهاز التنفسي بعد جراحة القلب المفتوح .
- اشرح للممرضة الفرق بين ممارسة التنفس العميق وحده، و ممارسة التنفس العميق مع العضو مناورة اخرى مثل مقياس التنفس الحافز أو جهاز زجاجة ضربة، و فعالية على الجهاز التنفسي لمنع مضاعفات في الجهاز التنفسي.